Trejo-Velasco Blanca, Estevez-Loureiro Rodrigo, Carrasco-Chinchilla Fernando, Fernández-Vázquez Felipe, Arzamendi Dabit, Pan Manuel, Pascual Isaac, Nombela-Franco Luis, Amat-Santos Ignacio J, Freixa Xavier, Hernández-Antolín Rosa Ana, Trillo-Nouche Ramiro, Andraka Ikazuriaga Leire, López-Mínguez José R, Sanmiguel Cervera Dario, Sanchis Juan, Diez-Gil José Luis, Ruiz-Quevedo Valeriano, Urbano-Carrillo Cristóbal, Becerra-Muñoz Víctor Manuel, Benito-González Tomás, Li Chi Hion, Mesa Dolores, Avanzas Pablo, Armijo Germán, Serrador-Frutos Ana María, Sanchis Laura, Lobán Covadonga Fernández-Golfín, Cid-Álvarez Belén, Hernández-García José María, Garrote-Coloma Carmen, Fernández-Peregrina Estefanía, Romero Miguel, León Arguero Víctor, Cruz-González Ignacio
Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain.
Cardiology Department, Alvaro Cunqueiro University Hospital, 36213 Vigo, Spain.
J Clin Med. 2021 Mar 2;10(5):1006. doi: 10.3390/jcm10051006.
Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA).
Multicentre registry including 228 consecutive patients that underwent successful TMVR with MitraClip. The sample was divided in two groups according to TAPSE/PASP median value: 0.35. The primary combined endpoint encompassed HF readmissions and all-cause mortality.
Mean age was 72.5 ± 11.5 years and 154 (67.5%) patients were male. HF readmissions and all-cause mortality were more frequent in patients with TAPSE/PASP ≤ 0.35: Log-Rank 8.844, = 0.003. On Cox regression, TAPSE/PASP emerged as a prognostic predictor of the primary combined endpoint, together with STS-Score. TAPSE/PASP was a better prognostic predictor than either TAPSE or PASP separately.
TAPSE/PASP ratio appears as a novel prognostic predictor in patients undergoing MitraClip implantation that might improve risk stratification and candidate selection.
经导管二尖瓣修复术（TMVR）是治疗重度二尖瓣反流（MR）高危患者的有效方法，但在中期随访中，心力衰竭（HF）再入院率和死亡率仍然很高。最近，右心室（RV）与肺动脉（PA）的耦合已成为HF的一个相关预后预测指标。在本研究中，我们旨在评估三尖瓣环平面收缩期位移（TAPSE）与肺动脉收缩压（PASP）之比作为接受MitraClip（美国加利福尼亚州雅培公司）TMVR患者RV与PA耦合的非侵入性测量指标的预后价值。
多中心注册研究，纳入228例连续成功接受MitraClip TMVR的患者。根据TAPSE/PASP中位数0.35将样本分为两组。主要联合终点包括HF再入院和全因死亡率。
平均年龄为72.5±11.5岁，154例（67.5%）患者为男性。TAPSE/PASP≤0.35的患者HF再入院和全因死亡率更高：对数秩检验8.844，P = 0.003。在Cox回归分析中，TAPSE/PASP与STS评分一起成为主要联合终点的预后预测指标。TAPSE/PASP作为预后预测指标比单独的TAPSE或PASP更好。
TAPSE/PASP比值似乎是接受MitraClip植入患者的一种新的预后预测指标，可能会改善风险分层和候选者选择。
